Rate Of Total Joint Arthroplasty Research Articles

Digital musculoskeletal program is associated with decreased joint replacement rates.

To compare 12-month total knee arthroplasty (TKA) and total hip arthroplasty (THA) rates for digital musculoskeletal (MSK) program members vs patients who received traditional care for knee or hip osteoarthritis (OA). Retrospective, longitudinal study with propensity score-matched comparison group that used commercial medical claims data representing more than 100million commercially insured lives. Study participants with hip OA (M16.x) or knee OA (M17.x) International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes were identified in the medical claims database. Digital MSK program members were identified using record linkage tokens. The comparison group had hip- or knee-related physical therapy identified via ICD-10-CM and Current Procedural Terminology codes. Respectively in each knee and hip OA group, digital members were matched to control group patients with similar demographics, comorbidities, and baseline MSK-related medical care use. TKA and THA at 12 months post participation were compared. In the knee OA group, 739 of 56,634 control group patients were matched to 739 digital members. At 12months, 3.79% of digital members and 14.21% of control group patients had TKA (difference, 10.42%; P < .001). In the hip OA group, 141 of 20,819 control group patients were matched to 141 digital members. At 12 months, 16.31% of digital members and 32.62% of control group patients had THA (difference, 16.31%; P = .001). These findings suggest that patients who participated in a digital MSK program to manage OA have lower rates of total joint arthroplasty in the 12 months afterenrollment.

Optimizing Total Joint Arthroplasty for Patients Living With Human Immunodeficiency Virus.

IntroductionSignificant advancements in human immunodeficiency virus (HIV) treatment have led to an increasing life expectancy among patients living with HIV (PLWH). Given this rise in life expectancy, as well as the ability to lead a more active lifestyle, the rate of total joint arthroplasty (TJA) in this population is increasing. Unfortunately, the current medical literature surrounding the safety and efficacy of TJA in this patient population is indeterminant. Therefore, the purpose of this study was to determine if optimization of PLWH prior to TJA would result in any changes in the incidence of postoperative complications and hospital length of stay (LOS) when compared to historically reported data. Materials and methodsA retrospective study was performed of all PLWH 18 years and older who underwent either a primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) between 2009 and 2019 at our academic institution. Medical records were reviewed for each patient to assess demographics, comorbidities, preoperative laboratory studies, operative details, length of hospital stay, complications, and follow-up time. Patients were optimized using our institution's current optimization guidelines: body mass index (BMI) less than 40 kg/m2, hemoglobin >12 g/dL, no tobacco use within 30 days of surgery, albumin >3.5 g/dL. Independent-sample t-tests and Pearson's chi-square tests were used to evaluate the continuous and categorical variables, respectively.ResultsThis study included 47 TJA in PLWH, including 14 TKA and 33 THA. Out of the 47 patients, 13 (27.7%) were fully optimized for all four variables: BMI, hemoglobin, non-smoking status, and albumin. There was no significant difference between the group of PLWH that was completely optimized and the group that was not in any patient characteristics, preoperative labs, intraoperative variables, or postoperative variables, including length of hospital stay and complications. A larger proportion of patients not completely optimized was found to be active smokers (p=0.0003). All complications occurred in cases in which the patients were not fully optimized. Subgroup analysis of PLWH, who were completely optimized, showed an average LOS of 4.3+/-1.5 days following TKA and 2.9+/-1.1 days following THA. Subgroup analysis of PLWH not completely optimized showed that each case was optimized for at least one variable and that those optimized for albumin had the largest (12.2%) number of complications.ConclusionPLWH can achieve a low rate of complications and LOS similar to that of the general population if medically and nutritionally optimized. Additional research is necessary to reveal well-defined parameters for achieving a higher rate of optimization prior to surgery in this important patient population.

Are Growing Rates of Total Joint Arthroplasty in Younger Patients of Concern?

Abstract Total joint arthroplasty (TJA) is being used more frequently now than in the past for younger patients who may not have radiographic evidence of severe osteoarthritis. This change is problematic. We will present evidence that younger patients, and those with early-stage osteoarthritis, benefit less from TJA than do older patients with late-stage osteoarthritis. The reasons for the increase in TJA among younger, healthier patients are complex and have economic and ethical implications. Outcomes of TJA are poorly studied in patients less than 55 years, and it is unclear whether many younger patients who undergo TJA have arthritis severe enough to warrant the procedure. TJA may be inappropriate for patients who have minimal pain and disability related to osteoarthritis and higher functional demands that stress the replaced joint. In this viewpoint, we discuss reasons for the increase in TJA among these patients and make ethics-based recommendations for avoiding inappropriate and costly TJA.

Assessing the Efficacy of Certificate of Need Laws Through Total Joint Arthroplasty.

Lawmakers suggest Certificate of Need (CON) laws' main goals are increasing access to healthcare, increasing quality of healthcare, and decreasing healthcare costs. This retrospective database study aims to evaluate the effectiveness of CON through analysis of total knee, hip, and shoulder arthroplasty (TKA, THA, and TSA, respectively). A review was performed using the Humana Insurance PearlDiver national database from 2007 to 2015. Access to care was approximated by the rates of total joint arthroplasty (TJA) in patients diagnosed with arthritis to the corresponding joint. The quality of care was assessed using complication rates after TJA. The total cost of TJA was approximated from average reimbursement to the healthcare facility per procedure. Patients in states without CON programs received TKA, THA, and TSA more frequently (p < .0001, p = .250, p = .019). No significant difference was found in studied complication rates between CON and non-CON states. Similarly, there was no trend found when comparing the cost of each procedure in CON versus non-CON states. These findings are consistent with other recent studies detailing the impact of CON regulation on THA and TKA. The apparent nonsuperiority of CON states in achieving their purported goals may call into question the effectiveness of additional bureaucracy and regulation, suggesting a need for further examination.

Streptococcus viridans periprosthetic joint infections

The increasing rate of total joint arthroplasty (TJA) in the United States will lead to more cases of periprosthetic joint infection (PJI), including those caused by Streptococcus viridans ( S. viridans ) group organisms, which are relatively rare culprits of infection. The S. viridans organisms are divided into five subfamilies based on specific criteria. Since the primary source of each subfamily is the oral cavity, the role of antibiotic prophylaxis prior to invasive dental procedures has been debated to best suit the interest of the patient. Diagnostic criteria have recently been standardized for all organisms responsible for PJI. Treatment regimens are determined by maximal antibiotic susceptibility based on the specific S. viridans subfamily identified. The collective information presented on S. viridans PJI in this review paper will help prepare orthopaedic surgeons in preventing and treating these difficult infections.

Impact of Race and Gender on Utilization Rate of Total Shoulder Arthroplasty.

Marked underutilization rates of total joint arthroplasty in minorities compared with nonminorities exist, with a paucity of literature surrounding inequities related to total shoulder arthroplasty (TSA). Using the Statewide Planning and Research Cooperative System database, patients who underwent elective TSA in New York State (NYS) were identified and characterized by age, race, gender, medical comorbidities, and payor status. Patients were stratified into 4 separate 5-year periods from 1990 to 2009. Comorbidity severity was defined using the Elixhauser criteria. A total of 10,538 elective TSAs were identified, with half of the procedures occurring in the most recent time quartile. Whites accounted for 70% of the procedures, whereas blacks accounted for 5%. During the 20-year period, the age-adjusted incidence of TSA in white men and women increased by 417% and 421%, respectively, whereas the incidence for black men and women increased by 378% and 329%, respectively. Black men had the lowest utilization rate among all subgroups, and overall disparity between races continued to widen over time. Blacks had significantly more comorbid conditions (P<.001) than whites when undergoing TSA. Blacks were more likely to have Medicaid insurance and less participation in Medicare (P<.001). Racial and gender disparities clearly exist in TSA utilization rates in NYS and may be worsening. Although reasons for these disparities are likely multifactorial, a deeper understanding of the factors involved in patient selection and access to care is necessary to appropriately address these disparities and effect change at a system-wide patient and provider level. [Orthopedics. 2016; 39(3):e538-e544.].

Perspectives of Canadian Stakeholders on Criteria for Appropriateness for Total Joint Arthroplasty in Patients With Hip and Knee Osteoarthritis.

As rates of total joint arthroplasty (TJA) for osteoarthritis (OA) rise, there is a need to ensure appropriate use. We undertook this study to develop criteria for appropriate use of TJA. In prior work, we used qualitative methods to separately assess OA patients' and arthroplasty surgeons' perceptions regarding appropriateness of patient candidates for TJA. The current study reviewed the appropriateness themes that emerged from each group, and a series of statements were developed to reflect each unique theme or criterion. A group of arthroplasty surgeons then indicated their level of agreement with each statement using electronic voting. Where ≤70% agreed or disagreed, the criterion was discussed and revised, and revoting occurred. In standardized telephone interviews, OA patient focus group participants indicated their level of agreement with each revised criterion. Qualitative research in 58 OA patients and 14 arthroplasty surgeons identified 11 appropriateness criteria. Member-checking in 15 surgeons (including 5 who had participated in the qualitative study) resulted in agreement on 6 revised criteria. These included evidence of arthritis on joint examination, patient-reported symptoms negatively impacting quality of life, an adequate trial of appropriate nonsurgical treatment, realistic patient expectations of surgery, mental and physical readiness of patient for surgery, and patient-surgeon agreement that potential benefits exceed risks. Thirty-six of the original 58 OA patient focus group participants (62.1%) participated in the member-check interviews and endorsed all 6 criteria. Patients and surgeons jointly endorsed 6 criteria for assessment of TJA appropriateness in OA patients. Prospective validation of these criteria (assessed preoperatively) as predictive of postoperative patient-reported outcomes is under way and will inform development of a surgeon-patient decision-support tool for assessment of TJA appropriateness.

Changing trends in cervical spine fusions in patients with rheumatoid arthritis.

Retrospective data analysis. To compare the trends in primary cervical spine fusion procedures in patients with rheumatoid arthritis (RA) against those in the general population. RA severely impacts multiple joints in the body and can result in substantial deformity and functional impairment. Cervical spine involvement is common. In the past decade, treatment for RA has changed substantially with the introduction of biologically based, disease-modifying antirheumatic medications. Recent literature has shown decreasing rates of total joint arthroplasty in patients with RA. Cases of cervical spine fusion in the general population and in patients with RA were identified from the Nationwide Inpatient Sample from 1992 through 2008. US population counts were obtained from the Census Bureau. Data were analyzed with computer software (significance, P < 0.05 for all analyses). Linear regression models were used to describe national rates of cervical spine fusion in patients with and without RA. There was a marked increase in the number of cervical fusion procedures in the studied population. Over time, the incidence of atlantoaxial fusion increased in the general population (P < 0.01) and decreased in patients with RA (P < 0.01). Compared with the general population, patients with RA had a significantly lower rate of increase in the incidence of posterior cervical fusion (P < 0.01) and a significantly higher rate of increase in the incidence of anterior cervical fusion (P < 0.01). In the US, the absolute number of primary cervical fusion procedures from 1992 through 2008 increased in the general population and in patients with RA. However, the patients with RA had a significantly lower incidence of undergoing atlantoaxial and posterior cervical surgical procedures than did the general population. 2.

The changing demographics of total joint arthroplasty recipients in the United States and Ontario from 2001 to 2007

The rates of total joint arthroplasty (TJA) of the hip and knee have increased in North America over the last decade. While initially designed for elderly patients (>70 years of age), several reports suggest that an increasing number of younger patients are undergoing joint replacements. This suggests that more people are meeting the indication for TJA earlier in their lives. Alternatively, it might indicate a broadening of the indications for TJA. We used the administrative databases available at the Healthcare Cost and Utilization Project (HCUP) and the Institute for Clinical Evaluative Sciences (ICES) to determine the rates of TJA of the hip and knee in the United States, and Ontario, Canada, respectively. We determined the crude rates of THA and TKA in both areas for four calendar years (2001, 2003, 2005 and 2007). We also calculated the age- and sex-standardised rates of THA and TKA in both areas for each time period. We compared the age distribution of TJA recipients between the US and Ontario, and within each area over time. The crude and standardised rates of THA and TKA increased over time in both the US and Ontario. The crude rates of THA were higher in the US in 2001 and 2003, but were not significantly different from the rate in Ontario in 2005 and 2007. The crude rates of TKA were consistently higher in the US for all time periods. In addition, the US consistently had more THA and TKA recipients in 'younger' age categories (<60 years of age). While the age- and sex-standardised rates of TKA were greater in the US in all time periods, the relative increase in rates from 2001 to 2007 was greater in Ontario (US - 59%, Ontario - 73%). For both the US and Ontario, there was a significant shift in the demographic of THA and TKA recipients to younger patients (p < 0.0001). The utilisation of primary hip and knee arthroplasty has increased substantially in both the US and Ontario in the period from 2001 to 2007. This increase has been predominantly in knee replacements. The demographics of joint replacement recipients has become younger, with substantial increases in the prevalence of patients <60 years old amongst TJA recipients, and significant increases in the incidence of TJA in these age groups in the general population, in both the US and Ontario.